Retracting tissue

ABSTRACT

A surgical retractor for retracting body tissue in a therapeutic procedure includes two lateral arms each having a block with an aperture extending transverse to a longitudinal axis of the arm. The distal end of each arm pivotably supports a retractor blade. A transverse extension, forming a retractor core, extends through the aperture and slideably supports a lateral arm at each end. A central arm also pivotably supports a retractor blade, and has an extension on a proximal end that is insertable into an aperture within the core. The lateral and central arms are translatable in connection with the core. The retractor blades can be pivoted by rotating a tool engagement. A rack and pinion, controlled by a pawl, is used to translate the side and central arms.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part application of Ser.No. 14/183,048, filed Feb. 18, 2014, and entitled “Retracting Tissue.”The reference is hereby incorporated by reference in its entirety.

FIELD OF THE INVENTION

The invention relates to a system and method for retracting body tissueduring surgery, and more particularly to multi-axis retractors affixedto a base.

BACKGROUND OF THE INVENTION

Retractor systems may be used in a variety of different surgicalprocedures to provide an opening through which a doctor may access thesurgical site. In spinal surgeries, for example, a retractor system maybe used to provide the surgeon with access to the patient's spine. Theopening created by the retractor system may, for example, enable thedoctor to insert surgical instruments into the body or enablevisualization of the surgical site using visible light or X-rays.

A retractor system may include a plurality of blades coupled to aretractor frame. In use, the blades may be inserted into an incision andthen retracted to displace tissue surrounding the incision along a pathto the surgical site. To minimize trauma to the tissue, this tissuedisplacement should generally be refined and controlled.

SUMMARY OF THE INVENTION

In accordance with an embodiment of the disclosure, a surgical retractorfor retracting body tissue in a therapeutic procedure comprises at leastone first arm defining proximal and distal ends and a first armlongitudinal axis extending therebetween, the distal end configured tosupport a retractor blade, the proximal end forming one of an extensionor a block having an aperture; at least one second arm defining proximaland distal ends and a second arm longitudinal axis extendingtherebetween, the distal end configured to support a retractor blade,the proximal end forming one of an extension or a block having anaperture; a core: (a) configured to form a slideable connection eachwith the at least one first arm and the at least one second arm, (b) theslideable connection with the at least one first arm formed as a blockhaving an aperture when the proximal end of the at least one first armforms an extension, the slideable connection formed as an extension whenthe proximal end of the at least one first arm forms a block having anaperture, (c) the slideable connection with the at least one second armformed as a block having an aperture when the proximal end of the atleast one second arm forms an extension, the slideable connection formedas an extension when the proximal end of the at least one second armforms a block having an aperture, (d) each first arm translatable usingthe slideable connection independently of translation of at least onesecond arm, (e) each second arm translatable using the slideableconnection independently of translation of at least one first arm, and(f) the distal end of at least one first arm and the distal end of atleast one second arm mutually separateable using the slideableconnection to thereby separate retractor blades supported upon the atleast one first arm and the at least one second arm.

In variations thereof, each first arm is translatable using theslideable connection along an axis transverse to the first longitudinalaxis, and each second arm is translatable using the slideable connectionalong the second longitudinal axis; there are two first arms and onesecond arm; the two first arms and one second arm formable into acannula; one or more retractor blades have a tapered end configured toretract tissue that is bone; at least one retractor blade is pivotallymounted to at least one of the at least one first arm and the at leastone second arm; pivoting the at least one retractor blade retractstissue, and separating at least one first arm from at least one secondarm retracts tissue; and/or at least one retractor blade is pivoted byrotating a threaded shaft.

In further variations thereof, the retractor further includes at leastone blade holder pivotally mounted to at least one of the at least onefirst arm and the at least one second arm; a blade is connected to eachof the at least one blade holder using a dovetail connection; and/or alight source is affixable to at least one retractor blade.

In yet further embodiments thereof, the therapeutic procedure isconducted in a surgical facility having a supporting surface includingan extension arm, the retractor further including a mount moveablyconnected to the core and configured to releasably connect to theextension arm; and/or the mount is moveably connected to the core by apivot.

In other variations thereof, the slideable connection between at leastone of the first and second arms and the core includes a rack and amating ratcheting pawl, the rack and pawl configured to control relativemovement of the at least one first and second arm and the core; theretractor further includes a pinion rotatably secured to one of the atleast one first and second arms and the core, the rack associated withthe other of the at least one first and second arm, the pinion rotatableto change a relative position of the at least one first and second armand the core; and/or the retractor further includes at least one of amanually engageable key and a tool engagement connected to the pinion,the key or the tool engagement rotatable to rotate the pinion.

In other embodiments thereof, the retractor further includes a bladeholder including a block affixed to at least one of the at least onefirst and second arms and defining an aperture and an extending flange;a blade retainer having an extension sized and dimensioned to beinsertable into the aperture; a threadable set screw connectable betweenthe blade retainer and the extending flange to retain the blade retainerin connection with the block; and/or the retractor further includes ablade holder including a block affixed to at least one of the at leastone first and second arms and defining an aperture and an extendingflange; a retractor blade having an extension sized and dimensioned tobe insertable into the aperture; a threadable set screw connectablebetween the retractor blade and the extending flange to retain theretractor blade in connection with the block.

In another embodiment of the disclosure, a surgical retractor forretracting body tissue in a therapeutic procedure comprises at least onefirst arm defining proximal and distal ends and a first arm longitudinalaxis extending therebetween, the proximal end defining a first blockhaving a first aperture, the first aperture defining a first aperturelongitudinal axis that is transverse to the first arm longitudinal axis,the distal end configured to support a retractor blade; a transverseextension extending through and slideably supporting at least one firstblock of the at least one first arm; at least one second arm definingproximal and distal ends and a second arm longitudinal axis extendingtherebetween, the proximal end defining a second extension, the distalend configured to support a retractor blade; and a second blockconnected to the transverse extension and having a second aperture sizedand dimensioned to slideably support at least one second extension, thesecond aperture defining a second aperture longitudinal axis that isnon-parallel with respect to the first aperture longitudinal axis, eachsecond arm translatable in connection with the second block along thesecond longitudinal axis, each first arm translatable in connection withthe transverse extension along the first aperture longitudinal axis, atleast one first arm translatable independently of translation of atleast one second arm, and at least one second arm translatableindependently of translation of at least one first arm.

In a yet further embodiment of the disclosure, a surgical retractor forretracting body tissue in a therapeutic procedure comprises at least onefirst arm defining proximal and distal ends and a first arm longitudinalaxis extending therebetween, the distal end configured to support aretractor blade, the proximal end forming one of an extension or a blockhaving an aperture; at least one second arm defining proximal and distalends and a second arm longitudinal axis extending therebetween, thedistal end configured to support a retractor blade, the proximal endforming one of an extension or a block having an aperture; a core: (a)configured to form a slideable connection each with the at least onefirst arm and the at least one second arm, (b) the slideable connectionwith the at least one first arm formed as a block having an aperturewhen the proximal end of the at least one first arm forms an extension,the slideable connection formed as an extension when the proximal end ofthe at least one first arm forms a block having an aperture, (c) theslideable connection with the at least one second arm formed as a blockhaving an aperture when the proximal end of the at least one second armforms an extension, the slideable connection formed as an extension whenthe proximal end of the at least one second arm forms a block having anaperture, (d) each first arm translatable using the slideable connectionalong an axis transverse to the first longitudinal axis, at least onefirst arm translatable independently of translation of at least onesecond arm, (e) each second arm translatable using the slideableconnection along the second longitudinal axis, at least one second armtranslatable independently of translation of at least one first arm, and(0 the distal end of at least one first arm and the distal end of atleast one second arm mutually separateable using the slideableconnection to thereby separate retractor blades supported upon the atleast one first arm and the at least one second arm.

In accordance with some exemplary embodiments, a retractor system can beprovided, comprising a first arm having a first retractor bladeconfigured to displace tissue, a second arm having a second retractorblade configured to displace tissue, and an engagement mechanism forengaging the first blade with the second blade to prevent movementbetween the first and second blades when the retractor system is in anon-extended position.

The retractor system can further comprise a third arm configured tosupport a posterior blade configured to displace tissue. The first arm,second arm and third arm can each be configured to be linearlytranslatable to be moveable with respect to each other. The engagementmechanism can be configured to lock the first blade with the secondblade to prevent movement between the first and second blades. Theengagement mechanism can comprise a tab disposed along a length of thefirst blade, and a slot configured along a corresponding length of thesecond blade configured to receive the tab.

The retractor system can further comprise a first docking pin sleeveprovided in the first blade configured to receive a docking pin, and afirst docking pin configured for placement in the first docking pinsleeve and configured to be threaded into a vertebral body of a patientto secure the retractor system.

The retractor system can further comprise a lengthening shim provided inthe first blade configured to extend past a lower tip of the first bladeto prevent tissue creep into the first blade. The retractor system canfurther comprise one or more detent stops provided along fixed,incremental locations along a length of the first blade. The retractorsystem can further comprise a lengthening shim detent tab configured toengage with one or more detent stops to allow for an adjustable heightof the lengthening shim along the fixed, incremental locations. The oneor more detent stops can be provided in 2.5 millimeter intervals. Theretractor system can further comprise a lengthening shim removal hole onthe lengthening shim configured to disengage the lengthening shim detenttab from the one or more detent stops using a removal tool.

The retractor system can further comprise a widening shim provided alonga lower portion of the first blade configured to extend past a lower tipof the first blade in a direction towards the second blade to preventtissue creep. The retractor system can further comprise one or moredetent stops provided along fixed, incremental locations along a widthof the first blade. The retractor system can further comprise a wideningshim detent tab configured to engage with the one or more detent stopsto allow the widening shim to extend past the first blade along thefixed, incremental locations. The one or more detent stops can beprovided in 1 millimeter intervals. The retractor system can furthercomprise a widening shim removal hole on the widening shim configured todisengage the widening shim detent tab from the one or more detent stopsusing a removal tool. The retractor system can further comprise one ormore etched areas along a blade tip of the first blade forneuromonitoring.

The retractor system can further comprise a third arm having a posteriorblade configured to displace tissue, and a disc shim secured to theposterior blade extending below the third blade to anchor the posteriorblade into a disc space.

In some exemplary embodiments, a retractor system can be provided,comprising a first arm located around a central bore of the retractorsystem supporting a first retractor blade configured to displace tissueand configured to be translated independently, a second arm locatedaround the central bore in proximity to the first arm and supporting asecond retractor blade configured to displace tissue and configured tobe translated independently, a tab disposed on a fixed location along alength of the first blade, and a slot disposed on a fixed location alonga length of the second blade corresponding to the tab and configured toreceive the tab to engage the first blade with the second blade andprevent movement of the first blade with respect to the second bladewhen the retractor system is in a non-retracted position.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings wherein:

FIG. 1 depicts a surgical retractor blade holder of the disclosure, theblades held in a configuration conforming to a cannula;

FIG. 2 depicts the retractor of FIG. 1, the blades relatively separatedin a manner operative to retract tissue of the body in a therapeuticprocedure;

FIG. 3 depicts a retractor of the disclosure, including manuallyoperable adjustment mechanisms for separating blades of the retractor,the blades in a closed configuration;

FIG. 4 depicts the retractor of FIG. 3, the blades in an openedconfiguration;

FIG. 5 depicts an alternative retractor of the disclosure, includingadjustment mechanisms operable with a tool, the blades in a closedconfiguration;

FIG. 6 depicts the retractor of FIG. 5, the blades in an openedconfiguration;

FIG. 7 depicts an alternative retractor of the disclosure, includingarticulated blade holding arms, and a plurality of frame mounts of thedisclosure;

FIG. 8 depicts a top view of the retractor of FIG. 7;

FIG. 9 depicts a top view of the retractor of FIG. 7, the blades in anopened position;

FIG. 10 depicts an alternative embodiment of a retractor of thedisclosure, illustrating a thumbwheel operated rack and pinionadjustment mechanism;

FIG. 11 depicts a blade mounting configuration of the disclosure;

FIG. 12 depicts the blade mounting configuration of FIG. 11, connectedto a retractor of the disclosure, the retractor configured with analternative frame mount of the disclosure;

FIG. 13 depicts a light source retained by a blade holder of thedisclosure;

FIG. 14 depicts an alternative blade type, and an alternative blademounting configuration, of the disclosure;

FIG. 15 depicts an alternative blade pitch mechanism of the disclosure;

FIG. 16 depicts an articulated blade holding arm in accordance with thedisclosure.

FIG. 17 is a diagram of the operative configuration of the retractor ofFIGS. 1-2, in an open configuration;

FIG. 18 depicts the retractor of FIG. 17, in a closed configuration;

FIG. 19 is a diagram of an alternative retractor of the disclosure, inan open configuration;

FIG. 20 depicts the retractor of FIG. 19, in a closed configuration;

FIG. 21 is a diagram of another alternative retractor of the disclosure,in an open configuration;

FIG. 22 depicts the retractor of FIG. 21 in a closed configuration;

FIG. 23 depicts an alternative retractor system in a closedconfiguration in accordance with some embodiments;

FIG. 24 depicts the retractor system of FIG. 23 in an open configurationin accordance with some embodiments;

FIG. 25 depicts the retractor system of FIG. 23 in an open configurationwith its posterior blade moved in accordance with some embodiments;

FIG. 26 depicts the retractor system of FIG. 23 in an open configurationwith its cranial caudal blades moved in accordance with someembodiments;

FIG. 27 depicts the retractor system of FIG. 23 in an open configurationwith its posterior and cranial caudal blades moved in accordance withsome embodiments;

FIG. 28 depicts a top view of the retractor system of FIG. 23 inaccordance with some embodiments;

FIG. 29 depicts a top view of the retractor system of FIG. 23 with thefixed plate removed in accordance with some embodiments;

FIG. 30 depicts a top perspective view of the retractor system of FIG.23 with its components separated from one another in accordance withsome embodiments;

FIG. 31 depicts a different top perspective view of the retractor systemof FIG. 23 with its components separated from one another in accordancewith some embodiments;

FIG. 32 depicts a top view of a portion of a three-blade retractorsystem in a closed or non-retracted position in accordance with someembodiments;

FIG. 33 depicts a top view of the retractor system of FIG. 32, with aportion removed to show mateable blade features in accordance with someembodiments;

FIG. 34 depicts a front view of a portion of a three-blade retractorsystem in a closed or a non-retracted position in accordance with someembodiments;

FIG. 35 depicts a top view of a portion of a two-blade retractor systemin a closed or non-retracted position in accordance with someembodiments;

FIG. 36 depicts a top view of the retractor system of FIG. 35, with aportion removed to show mateable blade features in accordance with someembodiments;

FIG. 37 depicts a front view of a portion of a two-blade retractorsystem in a closed or a non-retracted position in accordance with someembodiments;

FIG. 38 depicts a blade having a docking pin sleeve in accordance withsome embodiments;

FIG. 39 depicts a cross-sectional view taken along line A-A of FIG. 38;

FIG. 40 depicts a cross-sectional view taken along line B-B of FIG. 38;

FIG. 41 depicts a docking pin inside a docking pin sleeve in accordancewith some embodiments;

FIG. 42 depicts a blade having a lengthening shim in accordance withsome embodiments;

FIG. 43 depicts a cross-sectional view taken along line A-A of FIG. 42;

FIG. 44 depicts a cross-sectional view taken along line B-B of FIG. 42;

FIG. 45 depicts a blade having a widening shim in accordance with someembodiments;

FIG. 46 depicts a top perspective view of the blade having the wideningshim of FIG. 45;

FIG. 47 depicts a top view of a portion of a retractor system includinga blade having a widening shim in accordance with some embodiments;

FIG. 48 depicts a side view of a portion of a retractor system includinga blade having a widening shim in accordance with some embodiments;

FIG. 49 depicts a perspective view of a portion of a blade including adisc shim in accordance with some embodiments;

FIG. 50 depicts a view of a blade separated from a disc shim inaccordance with some embodiments; and

FIG. 51 depicts a front view of a blade having a disc shim in accordancewith some embodiments.

DETAILED DESCRIPTION OF THE INVENTION

As required, detailed embodiments are disclosed herein; however, it isto be understood that the disclosed embodiments are merely examples andthat the systems and methods described below can be embodied in variousforms. Therefore, specific structural and functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present subject matter in virtually anyappropriately detailed structure and function. Further, the terms andphrases used herein are not intended to be limiting, but rather, toprovide an understandable description of the concepts.

The terms “a” or “an”, as used herein, are defined as one or more thanone. The term plurality, as used herein, is defined as two or more thantwo. The term another, as used herein, is defined as at least a secondor more. The terms “including” and “having,” as used herein, are definedas comprising (i.e., open language). The term “coupled,” as used herein,is defined as “connected,” although not necessarily directly, and notnecessarily mechanically.

FIGS. 1-2 illustrate a retractor system 10 that can be used to retract apatient's body tissue in a surgical procedure in accordance with oneembodiment of the present disclosure. Retractor system 10 includes aplurality of retractor blades 300, and in this embodiment, a first blade312, a second blade 314, and a third blade 316. Blades 300 are eachcoupled to a retractor frame 100, which includes first, second, andthird arms 120, 140, and 160, each having a blade holder 200 for holdingand positioning a blade 300. In one use of this embodiment, arms 120 and140 are cranial/caudal blades, and blade 160 is a posterior blade,although other orientations and uses are contemplated. In an embodiment,each blade may be translated or indexed freely without a requirement toindex another blade. In the embodiment shown, arms 120 and 140 arelaterally located, and arm 160 is centrally located, although otherrelative dispositions are contemplated within the disclosure.

Retractor 10 is configured to be adjusted into a desired position, andthen releasably fixed to an operating table or other object in theoperating theatre, so that a relative position of retractor 10 and apatient can be controlled. Fixation of one or more of retractor 10 canbe accomplished using one or more of an operating room (OR) table clamp,a retractor table arm, an arm clamp, and a frame clamp, for example.

Arms 120, 140, and 160 are each linearly translatable to be moveablewith respect to each other. More particularly, arms 120 and 140 eachinclude a base 150 having a slot 152, sized to mateably receive and belinearly slideable upon an extension 154. In an embodiment, arms 120 and140 are mirror images of each other, although this is not necessary inorder to carry out all aspects of the disclosure. In the embodimentillustrated in FIGS. 1-2, extension 154 has a flattened profile, therebypreventing unintended rotation of arms 120, 140 with respect to eachother, and as described below, with respect to arm 160. Other mechanicalforms can be provided for extension 154, including for example acylinder with a key, to enable a like purpose. In an alternativeembodiment of the disclosure, any of arms 120, 140, and 160 can berotated with respect to other of arms 120, 140, and 160, where extension154 or 170 (described below) is non-keyed, for example cylindrical.

A threaded set screw (not shown), ratchet (shown in other embodimentsherein), or other mechanism can be provided to retain arm 120, 140, 160in a desired linearly translated position. A rack and pinionconfiguration, not shown in this embodiment, can be provided, formedbetween extension 154 providing the rack, and with a pinion rotatablyfree but displaceably confined within arm 120/140 and engaged with therack. A locking mechanism, for example a set screw or a ratchetmechanism, can be provided to affix extension 154, 170 at a desireddisplacement.

Arm 160, in this embodiment, includes an arm extension 170 whichtranslates within a slot 172 within a block 174, block 174 connected toextension 154, for example with screws, or by welding, adhesives, or anyother known means. In this manner, an orientation of extension 154maintains a desired or predetermined orientation with respect to slot172. Accordingly, as arms 120, 140 are translated upon extension 154, orextension segments 154 that are mutually connected, and as arm 160 istranslated within block 174, a relative path of arms 120, 140, and 160is maintained. Further, each arm 120, 140, 160 is independentlytranslatable with respect to the other arms. In this manner, a medicalpractitioner can retract tissue in a manner which best suits atherapeutic purpose. Arm extension 170 can be provided with an extensionstop 178, to prevent an undesired separation of arm 160 from a remainderof retainer 10.

As can be seen in FIGS. 1-2, arms 120, 140 are sized and dimensioned tofit underneath block 174 when arms 120, 140 are approximated. In thismanner, an overall dimension of retractor 10 is minimized, therebyreducing a physical obstruction introduced by retractor 10, andmaximizing visualization within the surgical site. Arm 160 can beadjusted and affixed in any translated position as described withrespect to arms 120, 160 upon extension 154, however a rack would beformed upon extension 170, and a pinion disposed within block 174.

It should be understood that in this embodiment, as well as otherembodiments herein, while arms 120, 140 are configured to form a slot,and translate upon an extension, they could be configured to includeextensions which translate within a block, as shown for arm 160.Similarly, arm 160 could form a block which slides upon an extension, asshown for arms 120, 140. In one aspect of the disclosure, the relativeconfiguration of arms 120, 140 and arm 160 provides for an optimalpackaging and a reduced physical profile, although various permutationsof blocks and extensions as described herein can be provided, which canproduce a reduced profile in a similar manner.

As can be seen in FIG. 1, blades 300 are aligned relative to each otherto form a tube 320. In an embodiment, tube 320 has a tapered end 322,and can function as a cannula. When retractor 100 is deployed, tube 320can be formed by inserting blades 300 into an incision or opening in apatient's body, or can be positioned cooperative with other cannulae, toprogressively increase a size of an opening in a body sufficient toadmit passage of tube 320 with a minimum of disturbance to body tissue.As body tissue relaxes, or when desired, blades 300 can be separated ormoved apart by moving arms 120 and 140 relatively apart. The relativeextent of movement of arms 120, 140 do not have to be uniform, and atdifferent times, enabling the medical practitioner to control a timingand extent of force exerted upon different portions of body tissuerelative to each blade 312, 314. Similarly, blade 316, in connectionwith arm 160, can be moved before, during, or after movement of eitherof arms 120, 140, to be closer or further from blades 312, 314.

As blades 312, 314, and 316 are moved relatively apart, a perimeterdefined by an exterior surface of blades 312, 314, and 316 is increased,moving body tissue apart, and increasing access to an area within thebody. A greater or fewer number of arms 120, 140, and 160 can beprovided upon retractor 10 in a like configuration as arms 120, 140, or160, each configured to move independently of all other arms.

As can be seen in FIG. 2, blades 312, 314, and 316 can be pivoted to beangled or pitched with respect to their respective arms 120, 140, 160.In this manner, distal ends 330 of blades 300 can be further separated,and the perimeter defined by the exterior surface of the blades can beenlarged, without a necessity of increasing an overall profile ofretractor 10, or moving arms 120, 140, 160 any further apart.

FIG. 1 depicts retractor 10 in a “closed” or non-retractedconfiguration, in accordance with one embodiment of the presentdisclosure. In the closed configuration, blades 312, 314, and 316 areradially disposed around a central bore 324 to form the substantiallyclosed, tube-shaped structure 320. FIG. 2 depicts retractor system 10 inan “open” or retracted configuration, in which blades 312, 314, 316 havebeen pitched by being pivoted about a pivot 210 connected to a proximalend 332 of a blade 300, and to an arm 120, 140, or 160. In the openconfiguration, blades 300 no longer form a tube-shaped structure that issubstantially closed.

Blades 300 can each be independently pitched or translated, and can beindependently pitched or translated with respect to other blades. A stopelement 212, in the embodiment shown, a flange, extends from bladeholder 200 and contacts arm 120, 140, or 160 at a desired extreme rangeof pivoting motion of blade holder 200 and associated blade 300. A screw(not shown) can be provided within aperture 214, which may be threaded,the screw configured to bear upon arm 120, 140, or 160 to cause pivotingof blade holder 200, or to function as a stop element operative tochange a maximum range of pivoting motion. Alternative embodiments aredescribed with respect to FIGS. 5-6 and 15, elsewhere herein.

Blade holder 200 is provided with a blade engagement profile 240extending between opposing ends of blade holder 200. Blades 300 areprovided with a blade holder profile 340 mateable with blade engagementprofile 240, whereby when profiles 240, 340 are mated, blade 300 can beretained upon blade holder 200 and be slideable along a length of bladeholder profile 340 so that a penetration of blade 300 with respect to apatient is adjustable. Further, blades 300 can be replaced with bladeshaving a different shape, size, or tissue engaging profile. In oneembodiment, blade holder profile 340 and blade engagement profile 240form a dovetail connection.

Additionally, blades 300 can be inserted after retractor 10 is fixed ina position with respect to a patient, whereby a blade can be slidupwards and away from the patient, and replaced, without a requirementto move retractor 10 or the patient. In this embodiment, blade holderprofile extends to a distal end 330 of blade 300, or blade holderprofile is configured to no longer provide a mating engagement along oneor more portions of a length of blade 300.

Blades 300 are affixed at a desired displacement along the length ofblade holder profile 340 by a friction fit between blade holder profile340 and blade engagement profile 240, or by a set screw or otherfastener (not shown) connected to blade holder 200 and contactable withblade 300 or blade holder profile 340.

Blades 300 can be provided with one or more docking pin slots 350 sizedand dimensioned to accept a docking pin (not shown), which can be usedto secure a blade 300 in a position with respect to body tissue throughwhich a pin is extended, for example into a vertebra. As all bladesengaged upon retractor 10 are mutually connected, each docking pin thusinserted contributes to the overall stabilization of retractor 10.

In an embodiment, retractor 10 is configured for an anterior approach tothe spine of the patient. In this embodiment, shown in FIGS. 1-2, arms120, 140 support caudal oriented blades, and arm 160 supports a cranialoriented blade. A range of pitch motion for blades 300 can include 0degrees (forming tube 320) to 20 degrees, although substantially largerangulation can be provided, for example 30, 40, or 50 degrees, or agreater range of angulation.

In surgical procedures where imaging is to take place, for example X-rayimaging, it is advantageous if at least blades 300 of retractor 10 areat least partially radiolucent, to foster visualization of the imagedarea. Accordingly, blades 300 can be fabricated using aluminum, carbonfiber, or polymeric materials, or any other sufficiently strong andradiolucent material, or combination of materials, which is known orhereinafter developed.

With reference to FIGS. 3-6, in an alternative frame embodiment 100A ofthe disclosure, retractor 10A includes elements similar to those of theembodiment of FIGS. 1-2, and bears similar reference numbers. In FIGS.3-4, arms 120A, 140A, and 160A support blades 300 in a manner similar toarms 120, 140, and 160 of FIGS. 1-2, but arms 120A, 140A form square orrectangular channels which translate upon extensions 154A. Similarly,arm 160A translates within a rectangular channel forming block 174A.Keys 180, 182, and 184 are positioned to be rotated by a medicalpractitioner while retractor 10A is deployed, thereby translating arm120A, 140A, or 160A. With additional reference to FIGS. 5-6 and 11, eachof keys 180, 182, and 184 are connected to a pinion (not shown)rotatably fixed to arm 120A, 140A for keys 180, 182, and to block 174Afor key 184. A toothed rack 186 is formed upon a side surface of eachextension 154A, and a similar toothed rack 188 is formed upon a sidesurface of arm 160. In this manner, rotation of key 180, 182, or 184causes a corresponding translational movement of arm 120A, 140A, and160A, respectively. In FIG. 4, keys 180 and 182 have been rotated toseparate arms 120A, 140A, and key 184 has been rotated to retract arm160A.

In FIGS. 5-6, as can be seen in frame embodiment 100B, in place of keys180, 182, and 184, tool engagements 190, 192, 194 are connected torotatably fixed pinions mateable with racks 186, 188. Tool engagements190, 192, and 194 are engageable by a driving tool, such as a hex orallen head driver. Accordingly, a driving tool (not shown) can berotated by a hand of a medical practitioner, or by an electrical orcomputer controlled actuator, to adjust a position of arms 120B, 140B,or 160B, and thereby change a position of one or more blades 300,including for example blades 312, 314, or 316. It should be understoodthat either a key 180 configuration, or a tool engagement 190configuration, as shown in FIGS. 3-6, can be provided in the embodimentof FIGS. 1-2.

With further reference to FIGS. 5-6, a blade pitch tool engagement 230,232, 234 is provided, rotatable using a tool as described with respectto tool engagements 190, 192, and 194, and operative thereby to change apitch of a blade 300 attached to blade holder 200.

More particularly, in one configuration, blade holder 200 is pivotallymounted at pivot 210, and blade pitch tool engagement 230, 232, and 234are each rotatably retained upon their respective blade holder 200.Threaded shaft 236 is keyed to prevent rotation, but is axiallydisplaceable by rotation of blade pitch tool engagement 230, 232, 234.As a result, shaft 236 can be caused to bear against arm 120B, 140B,160B to cause rotation of blade holder 200 about pivot 210, and tothereby change an angle of blade 300. In another embodiment, blade pitchtool engagement 230, 232, 234 is affixed to shaft 236, and shaft 236 isthreadably received within blade holder 200. Thus, as blade pitch toolengagement 230, 232, 234 is rotated, shaft 236 bears against itsrespective arm 120B, 140B, 160B. In a variation of this embodiment,shaft 236 is threadably received within arm 120B, 140B, 160B. Othervariations, including a threaded blade holder 200, can be provided. Inany of the foregoing embodiments, a biasing element (not shown) can beprovided to bias blade holder 200 in a closed or pitched position, wherea position of blade holder 200 is not positive controlled in eachdirection of rotation about pivot 210. It should be noted that in oneembodiment, the blade holder 200 may be positively controlled in eachdirection about the pivot 210. While not shown for all embodiments, itshould be understood that the foregoing blade holder pitch mechanismdescribed for FIGS. 3-6 can be provided for other embodiments herein.

FIG. 15 illustrates an alternative embodiment, including frame 100J, forcontrolling blade pitch. More particularly, changing an angulation orpitch of blade holder 200 is accomplished by rotating blade pitch toolengagement 230, which has an attached threaded shaft 302, within acorresponding threaded receiver 304 pivotally connected to blade holderat pin 306.

Blade pitch tool engagement 230, 232, or 234 can be engaged with a tool,for example an alien or hex wrench, or may be provided with a knurlednut or manually engageable key. In this configuration, blade 300 can bepitched at a theoretically infinite range of angles. Other embodimentscan be provided wherein blade 300 can be pitched at discrete stoppoints. A tool thus engaged can also be used to manipulate all orportions of retractor 10, or a separate tool engagement can be providedupon retractor 10 to enable manipulation of other components ofretractor 10 described herein.

With further reference to FIGS. 5-6, a ratcheting pawl 250 can beprovided, pivotable about pawl pivot 252, a pawl 250 provided for any orall actuators having a toothed rack, including arms 120B, 140B, and160B, and all other embodiments herein upon which a rack is formed. Apawl tooth 254 has a sloped surface configured to allow rack 186, 188 topass in one direction, but not an opposite direction. In the embodimentshown, pawl 250 enables arms 120B, 140B, and 160B to move apart,relative to each other. This operates to maintain tissue retractedduring a therapeutic procedure. When the procedure is complete, or it isdesired to otherwise remove retractor 10, pawl 250 can be rotated aboutpivot 252 to disengage pawl tooth 254 from rack 186, 188, whereupon key180, 182, and 184, or tool engagement 190, 192, or 194 can be rotated tochange a position of its associated arm.

In an alternative embodiment, pawl 250 does not include a sloped surfaceat pawl tooth 254, and accordingly the pawl must be retracted fromcontact with rack 186 or 188 to enable movement of the associated arm.

FIGS. 5-6 further illustrate a frame mount 142, which enables frame 100(or frame 100A, 100B, and other frame embodiments herein) of retractor10 to be mounted to a table or other supporting structure with a singlemounting point. A support coupling 450 is affixed to the supportingstructure with a rod (not shown) threadably or otherwise securablewithin an end of coupling 450. Coupling 450 includes a threaded rod 148and nut 148A extending from an end portion. Coupling 450 is insertedinto chamber 144 of frame mount 142, and the attached threaded rod ispassed into notch 146. Nut 148A is tightened to secure coupling 450 toframe mount 142, and thereby securing retractor 10 to a supportingstructure. The frame mount 142 illustrated includes two notches 146,thereby enabling a support coupling to be connected to either side, orto both sides, of frame mount 142. Two or more frame mounts 142 can beprovided, as illustrated in FIGS. 7-9, providing multiple or alternativemounting points for retractor 10. In FIGS. 7-9, it may be seen that armextension 160D is connected to arm 160C using a similar attachmentmechanism.

With further reference to FIGS. 5-6, a cam latch 220 is rotatablyretained upon blade holder 200, and is oriented to engage a slot (notshown) within blade 300. In this manner, blade 300 is releaseablyretained upon blade holder 200, and is prevented from sliding withinblade holder profile 340. Alternatively, cam latch 220 can overlap aprotrusion (not shown) formed upon blade 300.

The embodiment of FIGS. 7-9 is analogous to the embodiment of FIGS. 1-2and 3-6, however arms 120C, 140C include arm extensions 120D, 140D, andarm couplings 430 and 432. In one embodiment, rotation of coupling bladepitch tool engagements 430, 432 are configured to change a pitch ofblades 312, 314 in a similar manner as described with respect to bladepitch tool engagements 230, 232. However, by positioning thecorresponding pitch actuating components proximal with respect to blades300, less structure is imposed upon the target therapy site, improvingvisualization and manipulation within the target zone. Blade holders200D are configured to be compact, particularly as articulation does notneed to be supported near a blade 300 attachment.

In an alternative embodiment, engagements 430, 432 are coupled topinions which rotate upon a rack formed in arm 120C or 140C. Thus,rotation of engagements 430, 432 extend or retract arm extensions 120D,140D. Alternatively, engagements 430, 432 enable articulation of armextensions 120D, 140D when rotated in one embodiment, and when loosedand manipulated in another embodiment. Articulation can be carried outby pivoting arm extension 120D, 140D about a pivot defined by engagement430, 432, respectively. In a yet further embodiment, couplings 430, 432enable rapid replacement of arm extensions 120D, 140D. In a yet furtherembodiment, engagements 430, 432 are connected to threaded shafts (notshown), which lie within elongated slots 328. In this manner, armextensions 120D, 140D can be displaced laterally with respect to arms120C, 140C. In a variation of this embodiment, arm extensions 120D, 140Dcan be pivoted after lateral displacement within elongated slots 328. Anembodiment frame 100H having elongated slots 328 disposed within arm140D′ and arm extension 140H is shown in FIG. 16.

With reference to FIG. 10, an embodiment of a retractor 10 of thedisclosure includes a frame 100E combining various elements describedelsewhere herein, as indicated, and further includes thumbwheels 260 forchanging a relative offset of arms 120E, 140E. In an embodiment, apinion (not shown) rotatably connected to thumbwheel 260 engages rack186 to cause movement of arm 120E or 140E relative to extension 154E.

As can further be seen in FIG. 10, an additional moveable extension 170Ais provided with a rack 188A and pinion (not shown) controllable, inthis example, with a key 184A. A mounting block 288 is connected toblock 174, whereby extension 170A can be moved independently ofextension 170, and arm 188. In an embodiment, extension 170A isconnected to a supporting structure, frame 100E moveable with rotationof key 184A.

With reference to FIGS. 11-12, a compact blade holder 200F includes amounting block 270 extending from or affixable to a remainder ofretractor 10 using any known method. Block 270 includes a chamber 274sized to receive a mounting holder extension 272. A set screw 276 isthreadably retained within holder extension 272, and bears against ablock flange 278 when extension 272 is inserted within chamber 274 andset screw 276 is tightened. Alternatively, set screw 276 can be threadedinto block flange 278. In this manner, mounting holder extension 272 isreleasably securable within block 270, and is thereby attachable toretainer 10. A blade engagement profile 240 extends from holderextension 272, and is connectable to a blade 300 as described withrespect to FIGS. 1-2. In an alternative embodiment, blade 300 formsholder extension 272, and therefore is directly attachable to block 270as described above.

Referring now to FIG. 12, frame mount 142A includes a central bore 280through which a threaded screw 282 (not shown) can be passed, tothreadably engage frame 100. In this manner, frame mount 142A can berotated about an axis defined by bore 280 to a desired orientation. Inthis embodiment, a key 284 is connected to screw 282, and can be rotatedto tighten screw 282 and thereby affix a position of frame mount 142Arelative to frame 100.

In the embodiment of FIG. 12, screw 282 threadably engages a slideableblock that is retained within frame 100G with a dovetail connection 292,and is thereby longitudinally positionable within frame 100. Extension170G of arm 160G is slideably retained within slideable block 290, andmay be adjusted within block 290 using any of the methods disclosedelsewhere herein, including a rack and pinion configuration. In theembodiment shown, pinch bolts 294 can be rotated to tighten or loosenextension 170G.

Referring now to FIG. 13, a light source 500 can be affixed to blade300, or to blade holder 200. Light source 500 can be provided with ablade holder profile 340 mateable with a blade engagement profile 240 ofblade holder 200. Alternatively, light source 500 can be affixed toblade holder 200 or blade 300 using any known means, including forexample magnetic, hook and loop fastener, threadable faster, resilientattachment means, or adhesive. A target of focus of light emitted fromlight source 500 can be adjusted by changing a pitch of blade holder200, or by translating an associated arm 120, 140, 160, as needed.

With reference to FIG. 14, a variety of blade shapes 300 can be employedtogether with retractor 10 of the disclosure. In addition, while blades300 can be provided with a blade holder profile, as illustrated in FIGS.1-2, blades 300 can alternatively be configured with a splined shaft370, which can be mateable with a corresponding receiver provided uponblade holder 200 to secure retain blade 300, and to prevent rotation. Inthis manner, a wide variety of blade 300 styles and blade attachmentmechanisms may be employed together with the various embodiments of thedisclosure. In FIG. 14, blades 300A are configured to engage bone of thebody, for example vertebrae. Blades 300A include are angled at 372 toenable mounting blocks 200 to be positioned further from the targetsurgical zone, and are further provided with tapered ends 322A whichsecurely engage and retain bone. Accordingly, blades 300A do not form atube 320 in this embodiment. It may also be seen that blades 300/300Acan be provided in various lengths, widths, and if tubes 320 are formed,various lengths and diameter tubes. Blades 300/300A can be provided in avariety of sizes, including for example 8 mm to 18 mm wide, and lengthsfrom 110 mm to 200 mm, although substantially narrower, wider, shorter,or longer blades can be provided. Although two blade types areillustrated herein, a wide variety of blade types, styles, sizes andlengths can be used in accordance with the disclosure.

FIGS. 17-22 diagrammatically illustrate three possible embodiments forcarrying out the disclosure, wherein heavy outline represents a blockinto which an extension is slideable. In FIGS. 17-18, the embodiment ofFIGS. 1-2 is depicted, wherein block 174 is affixed to extension 154,thereby forming a fixed core. The remaining components, arms 120, 140,and 160, are slideable independently of each other upon and within thecore. In FIGS. 19-20, extensions 154′ and 154″ extend from arms 120′ and140′. Extensions 154′, 154″, and 160 slide at different height offsetswithin block 174, which alone forms the core within which the moveablearms slide. In FIGS. 21-22, arms 120 and 140 form blocks, as in FIGS.17-18, and arm 160 is formed as a block 174′, slideable upon extension160′, which is affixed to extension 154, extensions 160′ and 154 forminga core upon which the moveable arms slide. It should be understood thatonly a single arm 120 or 140 can be provided, or that multiple arms 120or 140, or multiple arms 160 can be provided, as benefit the therapeuticneeds of the patient.

Frame 100 and its constituent components (including variants 100A-100H)may be fabricated from any one or more, or combinations of, metals,polymers, carbon fiber or other composites, natural materials, or anyother materials having sufficient strength, durability, andbiocompatibility. Materials selected can be radiolucent or radiopaque,as desired.

In accordance with the disclosure, a single mounting location for aframe 100 of the disclosure enables a posterior blade (e.g. 316) to beindexed without moving the cranial caudal blades (e.g. 312, 314), aswell as allowing the cranial caudal blades to be indexed without movingthe posterior blade.

FIGS. 23-31 depict different views of an alternative retractor system inaccordance with some embodiments. The retractor system 610 includes anumber of features as in prior embodiments, including first, second, andthird blades 612, 614, 616; first, second, and third arms 620, 640, 660;and various engagement mechanisms for independently translating thevarious blades and arms. The retractor system 610 also includes a numberof novel features including a carriage actuator 672 and a third (e.g.,posterior) blade actuator 674 that provides different advantages duringa surgical procedure, as discussed in more detail below.

FIG. 23 depicts an alternative retractor system in a first or closedconfiguration in accordance with some embodiments. The retractor system610 comprises a frame including a first arm 620, a second arm 640 and athird arm 660 for holding and attaching one or more blades thereto. Afirst blade 612 having a first blade arm 613 attaches to the first arm620. A second blade 614 having a second blade arm 615 attaches to thesecond arm 640. And a third blade 616 having a third blade arm 617attaches to the third arm 660. The first blade arm 613 attaches to thefirst arm 620 via first fastener 621. The second blade arm 615 attachesto the second arm 640 via second fastener 641. The third blade arm 617attaches to the third arm 660 via third fastener 661. In someembodiments, the first and second blades 612, 614 can be consideredcranial caudal blades in view of their direction of movement, while thethird blade 616 can be considered a posterior blade.

The retractor system 610 is in a first or closed configuration wherebyeach of the blades 612, 614, 616 are adjacent one another. The retractorsystem 610 can advantageously be delivered into a patient in the closedconfiguration through an open, mini-open or minimally invasive incision.Once in the patient, each of the blades 612, 614, 616 is capable ofangulation to thereby expand and retract tissue. Furthermore, each ofthe arms 620, 640, 660 (and their associated blades) are capable ofmovement (e.g., translational) in one or more directions, to therebyexpand and retract tissue. In some embodiments, one or more blades 612,614, 616 are angulated away from one another. In other embodiments, oneor more blades 612, 614, 616 are translated away from one another. Inother embodiments, one or more blades 612, 614, 616 are both angulatedand translated away from one another. By separating the blades viaangulation or translational movement, this creates a second or openconfiguration.

Each of the blades 612, 614, 616 is capable of angulation.Advantageously, each of the blades 612, 614, 616 has its own individualmechanism to provide angulation, such that each blade can be angulatedindependently from one another. A first blade pitch tool engagement orblade angle actuator 630 angulates first blade 612. A second blade pitchtool engagement or blade angle actuator 632 angulates second blade 614.A third blade pitch tool engagement or blade angle actuator 634angulates third blade 616. In some embodiments, the blade angleactuators 630, 632, 634 are angulated by hand and/or an instrument. Insome embodiments, each of the blade angle actuators 630, 632, 634resides within a base plate. In some embodiments, the base plates pivotaround an axis, thereby accommodating the movement caused by theactuators 630, 632, 634.

Each of the arms 620, 640, 660 is capable of movement, such astranslational movement. First arm 620 is capable of linear movement viarotation of first tool engagement or linear actuator 690. The firstlinear actuator 690 can be rotated by hand and/or instrument. As thefirst linear actuator 690 is rotated, the lower portion of the actuator690 engages teeth 691 (shown in FIG. 24) as part of a rack and pinionsystem, thereby advantageously causing the first arm 620 to linearlytranslate. In some embodiments, rotation of the first linear actuator690 causes the first arm 620 to move laterally outward (e.g., away froma longitudinal axis that extends through the system frame), therebyseparating the first arm 620 from the second arm 640 and third arm 660.Rotation of the first linear actuator 690 in an opposite directioncauses the first arm 620 to move laterally inward (e.g., toward alongitudinal axis that extends through the system frame), therebybringing the first arm 620 closer to the second arm 640 and third arm660.

Likewise, second arm 640 is capable of linear movement via rotation ofsecond tool engagement or linear actuator 692. The second linearactuator 692 can be rotated by hand and/or instrument. As the secondlinear actuator 692 is rotated, the lower portion of the actuator 692engages teeth 693 (shown in FIG. 24) as part of a rack and pinionsystem, thereby advantageously causing the second arm 640 to linearlytranslate. In some embodiments, rotation of the second linear actuator692 causes the second arm 640 to translate or move laterally outward(e.g., away from a longitudinal axis that extends through the systemframe), thereby separating the first arm 620 from the second arm 640from the first arm 620 and third arm 660. Rotation of the second linearactuator 692 in an opposite direction causes the second arm 640 to movelaterally inward (e.g., toward a longitudinal axis that extends throughthe system frame), thereby bringing the second arm 640 closer to thefirst arm 620 and third arm 660.

In addition to accommodating linear lateral translation of one or morearms (e.g., the first and second arms that attach to the first andsecond cranial caudal blades), the retractor system 610 can also providelinear translation of one or more arms in a longitudinal direction thatruns along a length of the retractor system. In some embodiments, theretractor system 610 comprises a carriage actuator 672 that actuates amoveable carriage 670 to which the first arm 620 and the second arm 640are attached, thereby causing the first blade 612 and the second blade614 to translate in a longitudinal or anterior/posterior direction. Insome embodiments, the carriage actuator 672 actuates the moveablecarriage 670 via a rack and pinion system. In some embodiments, theretractor system 610 further comprises a posterior blade actuator 674that causes translation of the third arm 660, thereby causing the thirdblade 616 to translate in a longitudinal or anterior/posteriordirection. In some embodiments, the posterior blade actuator 674actuates the third arm 660 via a rack and pinion system.

In some embodiments, a fixed plate 680 is provided with a moveablecarriage or carriage plate 670 positioned thereunder. As shown in FIG.23, fixed plate 680 comprises an opening for receiving the third arm 660therethrough. In some embodiments, the third arm 660 is in the form of adovetail, whereby it forms a dovetail connection with the fixed plate680. A moveable carriage 670 is positioned on an underside of the fixedplate 680, and is configured to translate while holding the first blade612 and the second blade 614 via rotation of the carriage actuator 672.On an upper surface of the fixed plate 680, carriage actuator 672 andposterior blade actuator 674 extend therefrom.

Rotation of the carriage actuator 672 causes the carriage 670 to move ortranslate linearly in a longitudinal or posterior/anterior direction. Insome embodiments, the fixed plate 680 remains in place, while thecarriage 670 translates relative to the fixed plate 680. As the carriage670 is attached to both the first arm 620 and the second arm 640, whilethe first arm 620 is attached to the first blade 612 and the second arm640 is attached to the second blade 614, movement of the carriage 670causes translational movement of both the first blade 612 and the secondblade 614. Rotation of the carriage actuator 672 in a first directioncauses the first and second blades (e.g., the cranial caudal blades)612, 614 to move away from the third blade (e.g., posterior blade) 616.Rotation of the carriage actuator 672 in a second direction causes thefirst and second blades (e.g., the cranial caudal blades) 612, 614 tomove toward the third blade (e.g., posterior blade) 616.

Rotation of the posterior blade actuator 674 causes the third arm 660 tomove or translate linearly in a longitudinal or posterior/anteriordirection. As the third arm 660 is attached to the third blade (e.g.,the posterior blade) 616, movement of the posterior blade actuator 674causes translational movement of the third blade 616. Rotation of theposterior blade actuator 674 in a first direction causes the third blade616 to move away from the first and second blades (e.g., the cranialcaudal blades) 612, 614. Rotation of the posterior blade actuator 674 ina second direction causes the third blade (e.g., the posterior blade) tomove toward the first and second blades (e.g., the cranial caudalblades) 612, 614.

The carriage actuator 672 and the posterior blade 674 provide uniqueadvantages to the present system. For example, a surgeon may positionthe retractor system 610 such that the third blade 616 is next to orblocking a nerve (e.g., a femoral nerve), but may want to retract tissuefurther in a longitudinal direction. Rather than having to move theentire retractor system 610, the present retractor system 610 simplyallows the surgeon to rotate the carriage actuator 672, therebyproviding translation of the first and second blades 612, 614, withouthaving to move the entire system. In another example, a surgeon may havepositioned the retractor system 610 such that the first and secondblades 612, 614 are in a desired position, while the third blade 616 hasroom to be brought closer to a nerve (e.g., a femoral nerve). Ratherthan having to move the entire retractor system 610, the presentretractor system 610 simply allows the surgeon to rotate the posteriorblade actuator 674, thereby providing translation of the third blade 616without having to move the entire system, thus advantageously increasingretractor accuracy and saving time during a surgical procedure.

In some embodiments, the retractor system 610 further includes a firstattachment mechanism 696 and a second attachment mechanism 698 forattaching additional components to the frame. Each of the attachmentmechanisms 696, 698 extends from an upper surface of the retractorsystem 610. The attachment mechanism 696, 698 comprise extensions orprotrusions for which a component can be attached thereon. As shown inFIG. 23, the first attachment mechanism 696 is positioned closer to theblades 612, 614, 616 than the second attachment mechanism 698. In someembodiments, a fourth arm and/or blade can be attached to the firstattachment mechanism 696. In some embodiments, a table mount componentcan be attached to the second attachment mechanism 698, such that theentire frame with the blades can be attached to a table.

FIG. 24 depicts the retractor system of FIG. 23 in a second or an openconfiguration in accordance with some embodiments. As shown in thefigure, the first blade 612, second blade 614 and third blade 616 havebeen separated apart from one another. In some embodiments, the firstlinear actuator 690 has been rotated to move or translate the firstblade 612 away from the second blade 614 and the third blade 616.Likewise, the second linear actuator 692 has been rotated to move ortranslate the second blade 614 away from the first blade 612 and thethird blade 616. In the open configuration in FIG. 23, the bladesprovide a greater channel through which one or more instruments and/orimplants can be inserted through the retractor system 610.

FIG. 25 depicts the retractor system of FIG. 23 in a different second oropen configuration with its posterior blade moved in accordance withsome embodiments. Like the retractor system 610 in the previous figure,the retractor system 610 is in an open configuration whereby the firstblade 612, second blade 614 and third blade 616 are separated from oneanother. The first blade 612 has been moved away from the second blade614 and the third blade 616 via the first linear actuator 690, while thesecond blade 614 has been moved away from the first blade 612 and thethird blade 616 via the second linear actuator 692. In addition, asshown in FIG. 25, the third blade 616 (e.g., the posterior blade) hasbeen moved linearly away from the first and second blades 612, 614(e.g., the cranial caudal blades) via posterior blade actuator 674. Asshown in the figure, upon rotation of the posterior blade actuator 674,the third arm 660 moves back through the fixed plate 680 of the frame ofthe retractor system 610, thereby exposing a posterior portion 661 ofthe third arm 660.

FIG. 26 depicts the retractor system of FIG. 23 in a different second oropen configuration with its cranial caudal blades moved in accordancewith some embodiments. Like the retractor system in FIG. 24, theretractor system 610 is in an open configuration whereby the first blade612, second blade 614 and third blade 616 are separated from oneanother. As shown in FIG. 26, the carriage actuator 672 has been rotatedsuch that the carriage 670 attached to the first blade 612 and thesecond blade 614 has been translated linearly (e.g., in an anteriordirection). In other words, the first and second blades 612, 614 (e.g.,the cranial caudal blades) have been shifted anteriorly in accordancewith some embodiments. From FIG. 26, one can see how the carriage 670has been shifted relative to the fixed plate 680. In addition, the firstblade 612, second blade 614 and third blade 616 have been angulated viablade angle actuators 630, 632 and 634.

FIG. 27 depicts the retractor system of FIG. 23 in a different second oropen configuration with its posterior and cranial caudal blades moved inaccordance with some embodiments. Like the retractor system in FIG. 24,the retractor system 610 is in an open configuration whereby the firstblade 612, second blade 614 and third blade 616 are separated from oneanother. As shown in FIG. 27, the carriage actuator 672 has been rotatedsuch that the carriage 670 attached to the first blade 612 and thesecond blade 614 has been translated linearly (e.g., in an anteriordirection). In other words, the first and second blades 612, 614 (e.g.,the cranial caudal blades) have been shifted anteriorly in accordancewith some embodiments. From FIG. 27, one can see how the carriage 670has been shifted relative to the fixed plate 680. In addition, theposterior blade actuator 674 has been rotated such that the third blade616 (e.g., the posterior blade) has been moved linearly away from (e.g.,in a posterior direction) from the first blade 612 and the second blade614. From FIG. 27, one can see how the third arm 660 has been translatedlinearly such that at least a posterior portion 661 of it is now exposedfrom the fixed plate 680. In addition, the first blade 612, second blade614 and third blade 616 have been angulated via blade angle actuators630, 632 and 634. As shown by each of the configurations in FIGS. 24-27,the blades can have various spacings and angles relative to one another.

FIGS. 28 and 29 depict top views of the retractor system of FIG. 23 inaccordance with some embodiments. FIG. 28 shows the retractor system 610with the fixed plate 680, while FIG. 29 shows the retractor system 610with the fixed plate 680 removed. From these views, one can see how thevarious actuators and knobs actuate and translate the arms and blades ofthe retractor system. For example, one can see how rotation of the firstlinear actuator 690 causes a bottom gear portion of the actuator 690 toengage teeth 691 (shown in full view in FIG. 29), thereby causing thefirst arm 620 and first blade 612 to linearly translate. Rotation of thesecond linear actuator 692 likewise engages a different set of teeth 693(shown in full view in FIG. 30), thereby causing the second arm 640 andsecond blade 614 to linearly translate.

FIGS. 30 and 31 depict different top perspective views of the retractorsystem of FIG. 23 with its components separated from one another inaccordance with some embodiments. In particular, there are two distinctportions—a blade portion and a frame portion. The blade portion includesthe blades 612, 614, 616 and their respective arms 613, 615, 617, whilethe frame portion includes the fixed plate 680, carriage 670 and allactuator knobs. From these views, one can see how the blade portion isattached to the frame portion via first, second and third fasteners 621,641, 661 that are received through corresponding openings 623, 643, 663formed in the frame portion.

Below are additional advantageous features that can be used with any ofthe retractor systems discussed above. FIGS. 32-37 illustrate bladeengagement mechanisms that allow one or more blades to interlock, engageor attach to another. These engagement mechanisms, which can be in theform of one or more mating tabs, advantageously help to reduce movementbetween the blades, particularly when they are in a closedconfiguration. FIGS. 38-41 illustrate retractor blades including one ormore inner sleeves for receiving a docking element, such as a dockingpin. The docking pin can advantageously help to secure the blade to avertebra, thereby helping to stabilize the blade during surgery. FIGS.42-46 show a slidable lengthening shim that can be slid down a blade,thereby extending the tip of the blade. The lengthening shimadvantageously serves to increase the tip of the blade to prevent tissuecreep from occurring. FIGS. 47 and 48 show a slidable widening shim thatcan be slid down a blade, thereby extending the width of the blade. Thewidening shim advantageously serves to increase the width of the bladeto prevent tissue creep from occurring. FIGS. 49-51 show a slidable discshim that can be slid down a blade. The disc shim advantageously allowsa blade to anchor into a disc space, thereby providing greaterstabilization for the retractor systems and reducing the likelihood ofthe retractor system moving from a target site. These features arediscussed in more detail below.

FIGS. 32-37 illustrate blade engagement mechanisms that allow one ormore blades to interlock, engage or attach to another. FIG. 32illustrates a top view of a portion of a retractor system 700 that canbe used to retract a patient's body tissue in a surgical procedure inaccordance with one embodiment of the present disclosure. From thisview, one can see blade arms that attach to respective arms of a frame,such as first blade arm 710, second blade arm 720 and a third blade arm730. The first blade arm 710 can attach to a first arm of the frame viafirst fastener 721. The second blade arm 720 can attach to a second armof the frame via second fastener 741. The third blade arm 730 can attachto a third arm of the frame via third fastener 761.

In some embodiments, the first blade arm 710 can have a first blade 712disposed within the first blade arm 710, the second blade arm 720 canhave a second blade 722 disposed within the second arm 720, and thethird blade arm 730 can have a third blade 732 disposed within the thirdblade arm 730. In some embodiments, the first and second blades 712, 722can be deemed cranial/caudal blades, while the third blade 732 can bedeemed a posterior blade, although other orientations and uses arecontemplated. In some embodiments, each blade may be translated orindexed freely without a requirement to index another blade. In anembodiment shown, blade arms 710 and 720 are laterally located, andblade arm 730 is centrally located relative to the other blades arms,although other relative dispositions are contemplated within the presentdisclosure.

In some embodiments, the retractor system 700 can be configured to beadjusted into a desired position, and then releasably fixed to anoperating table or other object in an operating room. Fixation of one ormore portions of a retractor system 700 can be accomplished using, forexample, one or more of an operating room table clamp, a retractor tablearm, an arm clamp, a frame clamp or other similar device. Blade arms710, 720 and 730 can each be linearly translatable to be moveable withrespect to each other. In some embodiments, blade arms 710 and 720 canbe mirror images of each other, although this is not required.

In some embodiments, one or more blades 712 and 722 can have anengagement mechanism 750 to engage one blade with another duringinstallation of the retractor system or during a procedure. In someembodiments, at least one blade comprises a mateable tab, prong orextension that fits into an opening, recess or slot in another blade,thereby interlocking the blades. For example, blade 712 can have a tab752 that can extend along a length of the blade 712, and blade 722 canhave a slot 754 that can receive the tab 752 at a corresponding lengthof the blade 722. In some embodiments, the tab 752 can be integral tothe blade 712 or a separate component. For example, in some embodiments,the tab 752 can be formed monolithically with the blade 712, or can bewelded to the blade 712. In some embodiments, the slot 754 can beconfigured to frictionally engage with the tab 752 so that the tab 752is fittingly received by the slot 754. The engagement mechanism 750 canstabilize the retractor system 700 by keeping the blade 712 engaged withthe blade 722, and can result in stability between the arm 710 and arm720 such as during installation of the retractor system 700 or during aprocedure.

Various engagement mechanisms are contemplated by the present disclosureand are not limited to the tab 752 and slot 754 mechanisms describedherein. The engagement mechanism 750 can engage, mate or lock one bladewith the other, preventing movement of one blade with respect to theother during, for example, a procedure or installation of the retractor.In some exemplary embodiments, other engagement mechanisms can be used,such as a slot and a pin, a screw in a threaded hole, magnets, or othermechanisms allowing the blade 712 to be engaged or secured to the blade722. The engagement mechanism can be integral with the blades or aseparate component.

FIGS. 32-34 illustrate retractor system 700 in a “closed” ornon-retracted configuration, in accordance with an embodiment of thepresent disclosure. In the closed configuration, first blade 712, secondblade 722 and third blade 732 are radially disposed around a centralbore 740 to form a substantially closed, tube-shaped structure. Theblades can each be independently pitched or translated, and can beindependently pitched or translated with respect to other blades.

In some exemplary embodiments, as shown in FIGS. 35-37, a retractorsystem 800 can be provided with a two-blade configuration. The retractorsystem 800 can comprise a first blade 812 that extends from a firstblade arm 810 and a second blade 822 that extends from a second bladearm 820. In some embodiments, blades 812 and 822 can have an engagementmechanism 830 to prevent movement of one blade with respect to the otherduring installation of the retractor or during a procedure. For example,blade 812 can have a tab 832 that can extend along a length of the blade812, and blade 822 can have a slot 834 that can receive the tab 832 at acorresponding length of the blade 822. In some embodiments, the slot 834can be configured to frictionally engage with the tab 832 so that thetab 832 is fittingly received by the slot 834.

FIGS. 38-41 illustrate retractor blades including one or more innersleeves for receiving a docking element, such as a docking pin. In someembodiments, a retractor system 900 comprises one or more blades 910including a docking pin sleeve 920 provided therein. The docking pinsleeve 920 can be provided in an interior wall of the associated blade910. In some embodiments, the docking pin sleeve 910 can be receivedwithin a slot 930 formed along an inner wall of the blade 910. In someembodiments, the slot 930 can allow for various instruments to slidedown the blade 310 if desired. In some embodiments, a docking pin isreceived along the slot 930 and into the docking pin sleeve 920. Thedocking pin can advantageously engage bone, thereby helping to stabilizethe associated retractor blade in preparation for or during a surgicalprocedure.

As shown in FIG. 39, which is a cross-sectional view of the line A-Ashown in FIG. 38, in some embodiments, the docking pin sleeve 920 can bea hollow shaft within the blade 910 that allows for placement of adocking pin. In some embodiments, the docking pin sleeve 920 is a hollowcylindrical body, while in other embodiments, it can be other shapes,such as square or rectangular. As shown in FIG. 40, which is across-sectional view of the line B-B shown in FIG. 38, in someembodiments, one or more holes 926 are provided within the walls 922,924 of the docking pin sleeve 920 to accommodate a docking pin.

FIG. 41 depicts a docking pin inside a docking pin sleeve in accordancewith some embodiments. The docking pin 950, which can comprise a headportion and a threaded shaft, can be inserted through the docking pinsleeve 920. The docking pin 950 can slide down the docking pin sleeve920 and can be threaded into the vertebral body to anchor the retractorblade to a bone.

FIGS. 42-46 show a slidable lengthening shim that can be slid down ablade, thereby extending the tip of the blade. The lengthening shimadvantageously serves to increase the tip of the blade to prevent tissuecreep from occurring. In some exemplary embodiments, as shown in FIGS.42-46, a lengthening shim can be provided within a blade. For example, ablade 1010 can extend from a blade arm 1000, which will be attached to aretractor system frame.

A slot 1020 can be provided within the blade 1010 for instruments toslide down the slot for use in various procedures during and afterinstallation of the retractor system. In some embodiments, a lengtheningshim 1030 can be provided within the blade 1010. A lengthening shimdetent tab 1040 (shown in FIG. 44) can be provided on the lengtheningshim 1030 to adjust the height of the lengthening shim 1030 that extendsout of the retractor arm 1000. In some exemplary embodiments, one ormore detent stops 1050 (shown in FIG. 44) can be provided within theblade 1010 to engage with the lengthening shim detent tab 1040 to adjustthe height of the lengthening shim 1030. Any number of detent stops 1050can be provided at any fixed, incremental locations, and the presentdisclosure is not limited to any particular number or distance betweenthe detent stops 1050. For example, in some exemplary embodiments, fourdetent stops 1050 can be provided in 2.5 millimeter increments where thetop detent stop 1050 will keep the lengthening shim 1030 and blade 1010flush with the bottom of the retractor arm, and the bottom detent stop1050 will allow the lengthening shim 1030 and blade 1010 to extend belowthe retractor arm 1000 a distance of ten millimeters. In other words,the lengthening shim 1030 can be moved incrementally (e.g., inmillimeters), with the distance travelled between the stops serving asthe distance the lengthening shim 1030 can travel down the blade. Thelengthening shim 1030 can advantageously incrementally increase the tipof the blade 1040 and can prevent tissue creep underneath the blade1010. A lengthening shim removal hole 1060 can be provided to disengagethe lengthening shim detent tab 1040 with the detent stop 1050, using aremoval tool.

FIGS. 47 and 48 show a slidable widening shim that can be slid down ablade, thereby extending the width of the blade. The widening shimadvantageously serves to increase the width of the blade to preventtissue creep from occurring. In some exemplary embodiments, as shown inFIGS. 47 and 48, a widening shim can be provided within a blade. Forexample, a widening shim 1110 can be delivered down one or more blades.The widening shim prevents tissue from creeping in between adjacentblades, particularly when they are in an open configuration. Thewidening shim 1110 can be slidably provided down a slot 1120 formedwithin the blade 1100. The widening shim can be any length, and in someembodiments, is between 1-2 inches. In some exemplary embodiments, oneor more detent stops can be provided along a width of the blade 1100 toengage with one or more widening shim detent tabs to adjust the wideningshim 1110. Any number of detent stops can be provided at any fixed,incremental locations, and the present disclosure is not limited to anyparticular number or distance between the detent stops. For example, insome exemplary embodiments, ten detent stops can be provided in 1millimeter increments to allow the widening shim 1110 to extend past theblade edge a total of ten millimeters. In some embodiments, the wideningshim 1110 can advantageously prevent and block tissue creep underneatharound the sides of the blade 1100. A widening shim removal hole can beprovided to disengage the widening shim detent tab with the detent stop,using a removal tool.

As shown in FIG. 47, once a retractor 1160 is installed, the blades1162, 1164 can be moved from a closed to an open (or retracted)position. A gap 1170 can exist between adjacent blades 1162, 1164. Awidening shim 1110 can be slid down a blade 1162. The widening shim 1110includes a wall that extends in between the gap 1170, thereby preventingcreep from occurring in the gap 1170. In some embodiments, a wideningshim can also be provided within the blade 1164 to extend towards theblade in arm 1162. For example, when the retractor is opened a distancegreater than the widening shim 1110 can extend in blade 1162, a secondwidening shim in blade 1164 can be provided to extend past the blade1162 toward the blade 1162. In some exemplary embodiments, etched areas1150 can be provided along the blade tip 1140 for neuromonitoring.

FIGS. 49-51 show a slidable disc shim that can be slid down a blade. Insome embodiments, a disc shim can be provided to aid a posterior bladeof a retractor to be anchored into a disc space. This can providefurther stabilization of the retractor and a reduced chance of theretractor moving from an initial target. Referring to FIGS. 49-51, forexample, a disc shim 1210 can have an upper portion 1225 and a lowernarrower portion 1215. The lower narrower portion 1215 can be insertedwithin a slot 1230 in the posterior blade 1220, and the upper portioncan wrap around the edges of the posterior blade 1220 to keep it inplace. As shown in FIG. 51, as the disc shim 1210 slides down theposterior blade 1220, into the disc, locking tabs 1260 can be providedon outer edges of the posterior blade 1220 to engage the upper portion1225 of the disc shim 1210 and lock the disc shim 1210 in place once thedisc shim 1210 is fully extended, and can prevent the disc shim 1210from moving upwards. Further, stops 1270 can be provided along the outeredges of the posterior blade which can engage the upper portion 1225 ofthe disc shim 1210, and can prevent the disc shim 1210 from advancingdownward too far beyond the tip 1235 of the blade 1220 distally. Thelower narrower portion 1215 can allow for the posterior blade 1220 to beanchored into the disc space. In some exemplary embodiments, the discshim 1210 can have slots which can allow the edges of the disc shim 1210to be displaced outwards by using a removal tool. The removal tool canbe threaded into the disc shim 1210 to disengage the locking tabs 1260allowing the disc shim 1210 to be easily removed.

Various configurations of the retractor and shims are contemplated andare not limited by the embodiments described with reference to thefigures. For example, various sizes, shapes and types of retractors andshims are contemplated, and various materials can be used to constructthe various parts. For example, the retractor 100 and its constituentcomponents may be fabricated from any one or more, or combinations of,metals, polymers, carbon fiber or other composites, natural materials orany other materials having sufficient strength, durability andbiocompatibility. Material selected can be radiolucent or radiopaque, asdesired. The exemplary embodiments of the present disclosure providevarious advantages, such as providing stability of the blades of theretractor, securing the retractor and preventing tissue creep.

All references cited herein are expressly incorporated by reference intheir entirety. It will be appreciated by persons skilled in the artthat the present invention is not limited to what has been particularlyshown and described herein above. In addition, unless mention was madeabove to the contrary, it should be noted that all of the accompanyingdrawings are not to scale. There are many different features to thepresent invention and it is contemplated that these features may be usedtogether or separately. Thus, the invention should not be limited to anyparticular combination of features or to a particular application of theinvention. Further, it should be understood that variations andmodifications within the spirit and scope of the invention might occurto those skilled in the art to which the invention pertains.Accordingly, all expedient modifications readily attainable by oneversed in the art from the disclosure set forth herein that are withinthe scope and spirit of the present invention are to be included asfurther embodiments of the present invention.

What is claimed is:
 1. A surgical retractor system comprising: a frameportion comprising a fixed plate and a carriage; a first blade having afirst blade arm operably attached to the frame portion; a second bladehaving a second blade arm operably attached to the frame portion; athird blade having a third blade arm operably attached to the frameportion; wherein the first blade and the second blade are attached tothe carriage such that translation of the carriage causes the firstblade and the second blade to translate.
 2. The surgical retractorsystem of claim 1, wherein the carriage is positioned on an underside ofthe fixed plate.
 3. The surgical retractor system of claim 1, whereinthe first blade is attached to a first arm extending from the frameportion, the second blade is attached to a second arm extending from theframe portion, and the third blade is attached to a third arm extendingfrom the frame portion.
 4. The surgical retractor system of claim 3,wherein the third arm extends through the fixed plate.
 5. The surgicalretractor system of claim 4, wherein the third arm and the fixed plateform a dove-tailed connection.
 6. The surgical retractor system of claim1, wherein the frame portion comprises a first linear actuator forlinearly translating the first arm and a second linear actuator forlinearly translating the second arm.
 7. The surgical retractor system ofclaim 6, wherein the first linear actuator and the second linearactuator are each part of a rack and pinion system.
 8. The surgicalretractor system of claim 1, wherein the frame portion comprises acarriage actuator and a posterior blade actuator.
 9. The surgicalretractor system of claim 8, wherein rotation of the carriage actuatorcauses linear translation of the first blade and the second blade, androtation of the posterior blade actuator causes linear translation ofthe third blade.
 10. The surgical retractor system of claim 1, whereinthe frame portion further comprises a first blade angulation actuatorfor angulating the first blade, a second blade angulation actuator forangulating the second blade, and a third blade angulation actuator forangulating the third blade.
 11. The surgical retractor system of claim10, wherein each of the first blade, second blade and third blade can beangulated independently from one another.
 12. The surgical retractorsystem of claim 1, wherein at least one of the first blade, second bladeand third blade comprises a docking pin sleeve for receiving a dockingpin therethrough.
 13. The surgical retractor system of claim 1, whereinat least one of the first blade, second blade and third blade comprisesa slot for receiving a lengthening or widening shim therethrough.
 14. Asurgical retractor system comprising: a fixed plate; a carriagepositioned beneath the fixed plate; a first blade and a second bladeoperably attached to the carriage, wherein movement of the carriagecauses translation of the first blade and the second blade; and a thirdblade.
 15. The surgical retractor system of claim 14, wherein the thirdblade is attached to an arm that extends through the fixed plate. 16.The surgical retractor system of claim 15, wherein the arm forms adove-tail connection with the fixed plate.
 17. The surgical retractorsystem of claim 14, wherein the third blade is capable of movingrelative to the first blade and the second blade via a knob actuator.18. The surgical retractor system of claim 17, wherein the carriage iscapable of moving so as to move the first blade and the second bladerelative to the third blade via a different knob actuator.
 19. Thesurgical retractor system of claim 14, wherein the first blade and thesecond blade are capable of moving linearly outwardly from a centrallongitudinal axis that extends through the fixed plate.
 20. The surgicalretractor system of claim 19, wherein the first blade and the secondblade are capable of moving linearly outwardly via a first actuator thattranslates the first blade and a second actuator that translates thesecond blade.